NRNP 6665-01 Week 11 Final Exam Solutions 2026/2027
Complete Final Exam Guide | Actual Questions & Verified
Solutions | PMHNP Lifespan Psychiatry | Pass Guarantee
85 Evidence-Based Multiple-Choice Items | Integrated Child, Adult & Geriatric Psychiatry
| High-Order Clinical Judgment Focus
1. A 19-year-old college freshman is referred by student-counseling after 6 weeks of
insomnia, declining grades, and “weird thoughts.” He reports classmates can
“read his mind,” hearing a running commentary while walking, and believes his
computer camera watches him. He has no mood elevation, no substance use,
and no medical problems. PHQ-9 = 4, GAD-7 = 5, PSYRATS-AH = 18. His mother
has schizophrenia; father has type-2 diabetes. Mental-status exam: cooperative,
poor eye contact, linear but guarded, affect constricted, thought process
circumstantial with referential ideation, no suicidal plan. What is the most
accurate DSM-5-TR diagnosis?
A. Major depressive disorder with psychotic features
B. Brief psychotic disorder
C. Delusional disorder
D. Schizophreniform disorder
Correct Answer: D
Rationale: 1–6 months of continuous symptoms with attenuated functional
decline and first-rank auditory hallucinations meet schizophreniform criteria;
absence of prominent mood episode excludes psychotic depression. Brief
psychotic disorder lasts < 1 month; delusional disorder requires non-bizarre
delusions only.
2. A 17-year-old cis-female presents with 4 weeks of “racing thoughts,” decreased
need for sleep (3–4 h), spending sprees, hyper-sexuality with two new partners,
and 5 lb weight loss. She had a similar 3-week episode at age 15 that resolved
without treatment. Urine tox negative, TSH normal, no medical issues. CBCL
shows elevated aggressive & attention sub-scores. Which next step best
confirms bipolar I diagnosis?
A. Obtain serum cortisol
B. Collateral history from parents & school
, C. Order brain MRI with contrast
D. Start sertraline 25 mg for comorbid anxiety
Correct Answer: B
Rationale: Confirmation of previous manic episode (> 3 mood-congruent
symptoms with impairment) establishes lifetime manic episode required for
bipolar I; cortisol and imaging are low-yield in straightforward manic
presentation; SSRI risks switching.
3. A 72-year-old widowed accountant is brought by daughter for “memory lapses.”
He got lost driving to a familiar store, has misplaced bills, and repeats questions.
MoCA = 22/30 (minus 3 recall, 2 visuospatial, 1 attention). He scores 6 on
GDS-15. He takes metoprolol, atorvastatin, OTC diphenhydramine nightly for
sleep. Vital signs stable; labs reveal TSH 6.5 mIU/L (nl 0.4–4), B12 180 pg/mL
(low). Which diagnosis is most accurate at this time?
A. Major neurocognitive disorder due to Alzheimer’s disease
B. Major neurocognitive disorder due to multiple etiologies (possible B12
deficiency + hypothyroid)
C. Mild neurocognitive disorder, Lewy-body type
D. Persistent depressive disorder with cognitive impairment
Correct Answer: B
Rationale: Cognitive deficits + reversible contributors (hypothyroid, low-normal
B12, anticholinergic use) meet criteria for major NCD due to multiple etiologies;
no fluctuation, parkinsonism, or visual hallucinations to suggest Lewy-body.
4. A 9-year-old boy is evaluated for “constant worries.” For 8 months he worries
about tornadoes, parents’ safety, and grades; seeks reassurance 10–15× daily,
stomach-aches cause tardiness. SCARED score = 38 (parent), 34 (child). No tics,
no mood swings, BMI 50th %. Which first-line medication is best supported by
AACAP guidelines?
A. Sertraline 25 mg daily
B. Methylphenidate 10 mg BID
C. Risperidone 0.5 mg HS
D. Clonidine 0.1 mg patch weekly
Correct Answer: A
Rationale: SSRI (sertraline) has FDA approval for pediatric GAD ≥ 7 yrs and
strongest evidence; stimulants, antipsychotics, and α-agonists lack data for
primary GAD.
5. A 34-year-old veteran presents with 14 months of daily intrusive memories of IED
explosion, nightmares 4× week, avoids fireworks, hyper-startle, and guilt over
surviving. PCL-5 = 58; no substance use; TSH normal; no manic episode. He
failed 12 sessions VA CPT 2 yrs ago. He now requests medication. Which
, regimen is APA-guideline recommended first-line?
A. Sertraline 50 mg daily + twelve 90-min prolonged-exposure sessions
B. Paroxetine 20 mg + trauma-focused CBT
C. Topiramate 100 mg BID + mindfulness group
D. Prazosin 6 mg HS for nightmares only
Correct Answer: A
Rationale: SSRIs remain first-line pharmacotherapy for PTSD; combining with
evidence-based psychotherapy (prolonged exposure) improves remission.
Topiramate is second-line; prazosin monotherapy targets only nightmares.
6. A 26-year-old cis-female with borderline personality disorder has had 4
psychiatric admissions in 18 months for self-laceration after perceived
abandonment. She attends weekly DBT but continues cutting weekly. She
declines antipsychotics due to weight gain. Which pharmacologic adjunct best
reduces self-harm per Cochrane meta-analysis?
A. Lithium carbonate 900 mg daily (target level 0.8)
B. Lamotrigine 200 mg daily
C. Quetiapine XR 150 mg HS
D. Fluvoxamine 100 mg daily
Correct Answer: A
Rationale: Lithium significantly decreases suicidal behavior and self-harm in
mood-dysregulated cluster-B patients regardless of bipolar status; lamotrigine
lacks data for self-injury.
7. A 16-year-old transgender female (on estradiol 4 mg daily) endorses 3 weeks of
hopeless mood, anhedonia, fatigue, passive death wishes, and one aborted
hanging attempt. PHQ-A = 16, Columbia-Suicide-Severity = 6. She refuses
inpatient but will do intensive outpatient. Which medication strategy is safest?
A. Start sertraline 25 mg daily; re-assess in 1 week
B. Start fluoxetine 10 mg daily (FDA-approved for youth) with weekly follow-up
C. Start venlafaxine 37.5 mg XR daily (activating)
D. Start bupropion XL 150 mg daily (less sexual side effects)
Correct Answer: B
Rationale: Fluoxetine has FDA indication for pediatric depression and lowest
suicidality signal among antidepressants; weekly monitoring meets APA safety
guidelines. Sertraline is acceptable but fluoxetine has strongest youth evidence.
8. A 55-year-old man with cirrhosis (Child-Pugh B) develops depressive episode
after variceal bleed. PHQ-9 = 17, no mania, no active alcohol. Which
antidepressant is best in this hepatic impairment?
A. Duloxetine 30 mg daily
B. Citalopram 20 mg daily
Complete Final Exam Guide | Actual Questions & Verified
Solutions | PMHNP Lifespan Psychiatry | Pass Guarantee
85 Evidence-Based Multiple-Choice Items | Integrated Child, Adult & Geriatric Psychiatry
| High-Order Clinical Judgment Focus
1. A 19-year-old college freshman is referred by student-counseling after 6 weeks of
insomnia, declining grades, and “weird thoughts.” He reports classmates can
“read his mind,” hearing a running commentary while walking, and believes his
computer camera watches him. He has no mood elevation, no substance use,
and no medical problems. PHQ-9 = 4, GAD-7 = 5, PSYRATS-AH = 18. His mother
has schizophrenia; father has type-2 diabetes. Mental-status exam: cooperative,
poor eye contact, linear but guarded, affect constricted, thought process
circumstantial with referential ideation, no suicidal plan. What is the most
accurate DSM-5-TR diagnosis?
A. Major depressive disorder with psychotic features
B. Brief psychotic disorder
C. Delusional disorder
D. Schizophreniform disorder
Correct Answer: D
Rationale: 1–6 months of continuous symptoms with attenuated functional
decline and first-rank auditory hallucinations meet schizophreniform criteria;
absence of prominent mood episode excludes psychotic depression. Brief
psychotic disorder lasts < 1 month; delusional disorder requires non-bizarre
delusions only.
2. A 17-year-old cis-female presents with 4 weeks of “racing thoughts,” decreased
need for sleep (3–4 h), spending sprees, hyper-sexuality with two new partners,
and 5 lb weight loss. She had a similar 3-week episode at age 15 that resolved
without treatment. Urine tox negative, TSH normal, no medical issues. CBCL
shows elevated aggressive & attention sub-scores. Which next step best
confirms bipolar I diagnosis?
A. Obtain serum cortisol
B. Collateral history from parents & school
, C. Order brain MRI with contrast
D. Start sertraline 25 mg for comorbid anxiety
Correct Answer: B
Rationale: Confirmation of previous manic episode (> 3 mood-congruent
symptoms with impairment) establishes lifetime manic episode required for
bipolar I; cortisol and imaging are low-yield in straightforward manic
presentation; SSRI risks switching.
3. A 72-year-old widowed accountant is brought by daughter for “memory lapses.”
He got lost driving to a familiar store, has misplaced bills, and repeats questions.
MoCA = 22/30 (minus 3 recall, 2 visuospatial, 1 attention). He scores 6 on
GDS-15. He takes metoprolol, atorvastatin, OTC diphenhydramine nightly for
sleep. Vital signs stable; labs reveal TSH 6.5 mIU/L (nl 0.4–4), B12 180 pg/mL
(low). Which diagnosis is most accurate at this time?
A. Major neurocognitive disorder due to Alzheimer’s disease
B. Major neurocognitive disorder due to multiple etiologies (possible B12
deficiency + hypothyroid)
C. Mild neurocognitive disorder, Lewy-body type
D. Persistent depressive disorder with cognitive impairment
Correct Answer: B
Rationale: Cognitive deficits + reversible contributors (hypothyroid, low-normal
B12, anticholinergic use) meet criteria for major NCD due to multiple etiologies;
no fluctuation, parkinsonism, or visual hallucinations to suggest Lewy-body.
4. A 9-year-old boy is evaluated for “constant worries.” For 8 months he worries
about tornadoes, parents’ safety, and grades; seeks reassurance 10–15× daily,
stomach-aches cause tardiness. SCARED score = 38 (parent), 34 (child). No tics,
no mood swings, BMI 50th %. Which first-line medication is best supported by
AACAP guidelines?
A. Sertraline 25 mg daily
B. Methylphenidate 10 mg BID
C. Risperidone 0.5 mg HS
D. Clonidine 0.1 mg patch weekly
Correct Answer: A
Rationale: SSRI (sertraline) has FDA approval for pediatric GAD ≥ 7 yrs and
strongest evidence; stimulants, antipsychotics, and α-agonists lack data for
primary GAD.
5. A 34-year-old veteran presents with 14 months of daily intrusive memories of IED
explosion, nightmares 4× week, avoids fireworks, hyper-startle, and guilt over
surviving. PCL-5 = 58; no substance use; TSH normal; no manic episode. He
failed 12 sessions VA CPT 2 yrs ago. He now requests medication. Which
, regimen is APA-guideline recommended first-line?
A. Sertraline 50 mg daily + twelve 90-min prolonged-exposure sessions
B. Paroxetine 20 mg + trauma-focused CBT
C. Topiramate 100 mg BID + mindfulness group
D. Prazosin 6 mg HS for nightmares only
Correct Answer: A
Rationale: SSRIs remain first-line pharmacotherapy for PTSD; combining with
evidence-based psychotherapy (prolonged exposure) improves remission.
Topiramate is second-line; prazosin monotherapy targets only nightmares.
6. A 26-year-old cis-female with borderline personality disorder has had 4
psychiatric admissions in 18 months for self-laceration after perceived
abandonment. She attends weekly DBT but continues cutting weekly. She
declines antipsychotics due to weight gain. Which pharmacologic adjunct best
reduces self-harm per Cochrane meta-analysis?
A. Lithium carbonate 900 mg daily (target level 0.8)
B. Lamotrigine 200 mg daily
C. Quetiapine XR 150 mg HS
D. Fluvoxamine 100 mg daily
Correct Answer: A
Rationale: Lithium significantly decreases suicidal behavior and self-harm in
mood-dysregulated cluster-B patients regardless of bipolar status; lamotrigine
lacks data for self-injury.
7. A 16-year-old transgender female (on estradiol 4 mg daily) endorses 3 weeks of
hopeless mood, anhedonia, fatigue, passive death wishes, and one aborted
hanging attempt. PHQ-A = 16, Columbia-Suicide-Severity = 6. She refuses
inpatient but will do intensive outpatient. Which medication strategy is safest?
A. Start sertraline 25 mg daily; re-assess in 1 week
B. Start fluoxetine 10 mg daily (FDA-approved for youth) with weekly follow-up
C. Start venlafaxine 37.5 mg XR daily (activating)
D. Start bupropion XL 150 mg daily (less sexual side effects)
Correct Answer: B
Rationale: Fluoxetine has FDA indication for pediatric depression and lowest
suicidality signal among antidepressants; weekly monitoring meets APA safety
guidelines. Sertraline is acceptable but fluoxetine has strongest youth evidence.
8. A 55-year-old man with cirrhosis (Child-Pugh B) develops depressive episode
after variceal bleed. PHQ-9 = 17, no mania, no active alcohol. Which
antidepressant is best in this hepatic impairment?
A. Duloxetine 30 mg daily
B. Citalopram 20 mg daily
